Spinal Cord Compression

Spinal Cord Compression

Written by – Ashly Liu

Spinal Cord Compression Shownotes

Spinal cord compression is when arterial, venous and cerebrospinal fluid spaces or the cord are compressed or displaced. 

Differentials include

• Trauma including MVA, falls, and osteoporotic fractures.
• Intervertebral disc herniation
• Malignancy, including metastases
• Spinal epidural abscess

Common Presentation

Patients can present in a variety of ways depending on the level of the spine that is affected. 

The typical clinical findings of pain, sensory changes (numbness and paraesthesia) and motor changes (weakness or paralysis) can be seen in most forms of spinal compression. Other signs also include hyperreflexia and sphincter dysfunction (urinary or anal). Concerning signs would be an acute onset of pain or bowel/bladder changes. 

Risk factors

• Trauma – motor vehicle accident or high-risk sports activities
• History of malignancy
• Immunosuppression
• Intravenous drug use

Red Flags: Acute onset and duration of symptoms

Investigations

The diagnostic investigation for spinal cord compression is an MRI spine.

Management 

Trauma

1. Immobilisation with a cervical collar, including trauma review
2. For confirmed spinal injury, urgent neural decompression and spinal stabilisation (within 24 hours)
3. Management of complication
   1. DVT prophylaxis
   2. Autonomic dysfunction +/- prevention of hypotension 
   3. Prevention of stress ulceration with PPI for at least four weeks
   4. Nutritional support

Intervertebral disc compression 

1. Emergency neurosurgery surgery for spine decompression (within 48 hours after onset of symptoms.
2. Management of complication
   1. DVT prophylaxis
   2. Autonomic dysfunction +/- prevention of hypotension 
   3. IDC + laxatives for bowel and bladder dysfunction
   4. Prevention of stress ulceration with PPI for at least four weeks
   5. Nutritional support
   6. Pressure injury prevention

Malignant Spine compression

1. Analgesia + bowel/bladder management with IDC
2. Corticosteroids
3. Decompressive laminectomy/vertebrectomy and/or radiotherapy

Epidural abscess

1. IV antibiotics depending on the pathogen (S. aureus, Strep, Pseudomonas, E. Coli, Mycobacterium TB)
2. Surgery with cord decompression, including tissue sampling
   1. For less disabling symptoms, CT-guided needle aspiration of lesions

References

BMJ – Spinal Cord Compression “https://bestpractice.bmj.com.acs.hcn.com.au/topics/en-gb/1012”